How do Republicans respond to stories like Stacey Lihn's?

[lance strongarm]

Originally Posted by Terr

Democrats think that Republicans' attitude is "I've got mine, screw you." Yet the story in the OP is the ultimate in "I've got mine, screw you.". It is "I've got my millions in health care, screw all of you who have to pay for me."

False.

Anyone has the same right to millions in health care, even you - if, God forbid, you need it.

The attitude of the OP is "I've got a desperate situation, thank you for helping me, and you'll get the same help from me and the rest of us if you ever need it." You know, how insurance works. Or civilization.

It's legitimate to question whether that help should be unlimited, but your comment goes far beyond that.

[Jas09]

Originally Posted by Terr

Democrats think that Republicans' attitude is "I've got mine, screw you." Yet the story in the OP is the ultimate in "I've got mine, screw you.". It is "I've got my millions in health care, screw all of you who have to pay for me."

Yup, that lucky ducky 6-month-old baby girl looking forward to her third open-heart surgery and potential transplant. I'm sure as she gets wheeled in to the operating room her final thought before going under will be "screw all of you".

[Terr]

Originally Posted by lance strongarm

It's legitimate to question whether that help should be unlimited, but your comment goes far beyond that.

If you think the help should be limited, your position, in principle, is not different from Republicans. It's the "now we know you're a whore, we're just arguing about the amount" thing.

[lance strongarm]

Originally Posted by Terr

If you think the help should be limited, your position, in principle, is not different from Republicans.

I didn't say I think that, but I'm not talking about their position. I'm talking about your post.

[Terr]

Originally Posted by lance strongarm

I didn't say I think that, but I'm not talking about their position. I'm talking about your post.

My post is, you buy insurance, you accept the terms of insurance. Having ACA force certain terms on the insurance companies raises costs for all of us. So yes, they've got theirs and screw all of us.

[lance strongarm]

Originally Posted by Terr

My post is, you buy insurance, you accept the terms of insurance. Having ACA force certain terms on the insurance companies raises costs for all of us. So yes, they've got theirs and screw all of us.

No, because now you also have a claim to unlimited lifetime expenses should you have a desperate, dying child or whatever. And don't think it can't happen to you.

[LavenderBlue]

Originally Posted by Terr

Democrats think that Republicans' attitude is "I've got mine, screw you." Yet the story in the OP is the ultimate in "I've got mine, screw you.". It is "I've got my millions in health care, screw all of you who have to pay for me."

If she were still in the womb the Republicans would be all lecturing us about her right to life. Why does that change when someone besides the pregnant woman and the father have to pay for her life?

Originally Posted by Terr

My post is, you buy insurance, you accept the terms of insurance. Having ACA force certain terms on the insurance companies raises costs for all of us. So yes, they've got theirs and screw all of us.

Insurance companies raise the cost for all of us. If Obama had any guts on this issue they would be driven out of business so we could cut out the middleman.

[Terr]

Originally Posted by BobLibDem

Their profits are irrelevant. It's the cost of having insurance companies exist that drives up the cost of health care. It's the medical loss ratio that matters. Insurers have to pay 85% of their premiums on health care- that's a 15% cut for them. Take them out of the equation and have Medicare for all with its medical loss ratio of 98%.

That 98% is a mirage. Private insurance companies have collection mechanisms for their premiums. Medicare outsources that collection mechanism to IRS and Social Security, transferring that cost there, and doesn't show it for its own "administrative costs", but that doesn't mean it goes away. HHS also does a lot of administrative duties for Medicare, but that cost is not included in Medicare's "administrative costs". Medicare also has a much higher fraud problem than do private insurers- *because* they don't spend money fighting it like the private insurers do. Estimates are for about $60B/year in fraud for Medicare - there's your 12-15% right there.

Just found this: http://www.forbes.com/sites/aroy/201...trative-costs/

Enjoy.

[That Don Guy]

Originally Posted by tightscience

My son has the same heart defect as Stacey Lihn's daughter so I am very familiar with the medical procedures and also insurance issues. The most common amount for a lifetime cap was $1 million. Sometimes it was $500,000. My son, like Stacey Lihn's daughter, has undergone two of the three open heart surgeries he will need to survive, and in our case, each one cost our insurance company about $300,000. The overall cost can vary dramatically depending on what complications arise. He has also required several other procedures requiring overnight hospital stays, and those cost at least $30,000. My son has been relatively fortunate in that he has had no major complications associated with his surgeries. I know some kids with the same disorder who have spent as long as 2 years as an inpatient, most of that time in intensive care. He also takes several very expensive medications every day.

Which brings up the question I don't see asked yet in this thread:
Why is health care so expensive?
Why does a surgery cost $300,000? Would it be any less if the hospital didn't know that the insurance company could cover it easily? (How many prescription drug companies work on this principle - or do those "If you cannot afford this medication, our company may be able to help" disclaimers mean something else?) How much of that is to cover the possibility of a multi-million-dollar-plus-25%-for-the-lawyers suit if something goes wrong?

One other thing I never quite understood: if things like lifetime caps and bans on having pre-existing conditions are such a problem, then why didn't some insurance company get rid of them already, and use it as a selling point?

[Zebra]

Originally Posted by adaher

Funny thing is, the NHS is better than the US at preventing deaths, but not THAT much better. Given that 20% of Americans don't have health insurance, our preventable deaths should be 20% more. But it's actually only 14% worse than the UK:

http://en.wikipedia.org/wiki/Health_care_system

That's why I disagree with the premise. There's no guarantee at all that this newborn would have done better in the NHS.

So health insurance only prevents death? Just because we have 20% with no insurance does not mean that mean our preventable deaths will be 20% more. So 14% percent more is OK?

[Jas09]

Originally Posted by That Don Guy

Which brings up the question I don't see asked yet in this thread:
Why is health care so expensive?

Because people will pay basically any price to save their 6-month-old daughter's life. There is no law of supply and demand because there is no limit on the demand.

Why does a surgery cost $300,000? Would it be any less if the hospital didn't know that the insurance company could cover it easily?

Maybe. It would certainly be cheaper with less training for the surgeon. And that cost might be the billed cost, might be the insurance paid cost, might be the out-of-pocket cost - it's very hard to know.

(How many prescription drug companies work on this principle - or do those "If you cannot afford this medication, our company may be able to help" disclaimers mean something else?)

Prescription drugs are priced at the point that maximizes revenue, just like everything else. They have to negotiate with the insurance companies to some extent, but not with Medicare for Part D (as I understand it).

How much of that is to cover the possibility of a multi-million-dollar-plus-25%-for-the-lawyers suit if something goes wrong?

Very little.

One other thing I never quite understood: if things like lifetime caps and bans on having pre-existing conditions are such a problem, then why didn't some insurance company get rid of them already, and use it as a selling point?

Because if you are the only company offering no-limits policies to people with pre-existing conditions you either have to require a premium nobody can pay or you will go out of business. Or you have to be the US Government. Or you have to have a mandate to require that healthy people buy your policies as well to spread the risk and lower the required premium.

[lance strongarm]

Originally Posted by Jas09

Because people will pay basically any price to save their 6-month-old daughter's life. There is no law of supply and demand because there is no limit on the demand.

But there are only so many dying children. That's the limit. Doctors aren't taking bids at auction and saving the highest bidders.

It's more complicated.

[tightscience]

Originally Posted by That Don Guy

Which brings up the question I don't see asked yet in this thread:
Why is health care so expensive?
Why does a surgery cost $300,000? Would it be any less if the hospital didn't know that the insurance company could cover it easily?

The rate the insurance company pays is actually substantially less than the amount billed. We received a bill for almost $1 million for my son's first surgery, and the insurance company actually paid more like $300,000. Hospitals receive fixed rates of compensation from insurance companies and Medicare for certain procedures. Of course, my son's hospital is a public hospital, so many of their patients have no health coverage. These people will be billed at the full rate and will never be able to pay their bills. This amount is covered by charging everyone else more.

Even without this, though, pediatric open heart surgery is going to be expensive. First you have the salaries: my son's surgeon makes a salary of almost $2 million a year (he works for a public hospital so his salary is public information). In the operating room you also have a team of specialized pediatric cardiac anesthetists, nurses, technicians, etc. You are putting in specialized hardware (shunts and stents) that cost a lot of money because relatively few of these are made for the pediatric market. Then as the child recovers, they will spend several days in the ICU where there is a 1:1 nurse to patient ratio 24 hours a day. There are also respiratory therapists, child life specialists, a team of cardiologists and others involved in their post-op care. But yeah, everything is inflated to cover the costs of patients who will never pay their bills.

As to your question about why companies didn't just get rid of lifetime caps and use that as a selling point, some companies did do this. Our insurance has actually never had a lifetime cap. But most employers want to offer their employees health insurance with the lowest premiums possible (especially if they are paying for all or most of the premiums!). Usually cost savings trumps all other concerns.

[BrainGlutton]

Originally Posted by adaher

It's a good thing our ancestors weren't so selfish as to spend our money trying to perfect their societies and eliminate all want.

Originally Posted by adaher

Our ancestors should have destroyed our futures to make their present a little better?

What you are describing out not have destroyed our futures. Quite the reverse.

[WillFarnaby]

The family should continue to use their insurance and personal wealth to care for the child until they can no longer afford it. When this happens they should enroll in Medicaid.

[BigAppleBucky]

Babies are only protected until birth. After that, they're on their own.

[Damuri Ajashi]

Originally Posted by Terr

Democrats think that Republicans' attitude is "I've got mine, screw you." Yet the story in the OP is the ultimate in "I've got mine, screw you.". It is "I've got my millions in health care, screw all of you who have to pay for me."

Fucking greedy baby with a heart defect. So fucking selfish.

[Patty O'Furniture]

I wish I had Amoria Phlebitis

[lance strongarm]

Originally Posted by WillFarnaby

The family should continue to use their insurance and personal wealth to care for the child until they can no longer afford it. When this happens they should enroll in Medicaid.

I trust that this was parody.

[Bricker]

Originally Posted by Leaper

See, I'd have more respect for Republicans/conservatives/libertarians if only they acknowledged certain truths about their beliefs. Bricker was willing to stand up and say "yes, it's okay for people to die of treatable medical conditions because they can't afford the bills." If politicians did that, and explained why it's better for us as a society to let that happen, I could at least accept and argue against an honest rationale.

Of course, I have explained before that, just as pkbites asks upthread, arithmetic suggests that it's not only okay, but completely necessary. We can always imagine a point at which some huge expenditure of dollars would allow us to extend a patient's life, but we cannot afford to pay that money. Where and how we draw that line is fruitful area for discussion -- that the line exists somewhere seems pretty self-evident to me.

Or is anyone here actually taking the position that, as a society, we should never limit the dollars spent on any patient, under any circumstances?

[lance strongarm]

Originally Posted by Bricker

Or is anyone here actually taking the position that, as a society, we should never limit the dollars spent on any patient, under any circumstances?

I think that's what critics are saying the policy banning lifetime limits already does.

It's a legitimate question. Part of the high costs of health care springs from the fact that we have awesome, but expensive, technology and treatments today. Who knows how far, or how expensive, they will get? Will we invent something that can keep people alive until age 200, that costs a billion dollar per person?

[Double Foolscap]

That's why we should invest in cyborg technology, so everybody we save can give back to society more than they did before. Sure, my throat surgery cost ludicrous amounts of money, but think how useful I'll be as a festival PA system and recording studio autotuner!

[iiandyiiii]

Originally Posted by Bricker

Of course, I have explained before that, just as pkbites asks upthread, arithmetic suggests that it's not only okay, but completely necessary. We can always imagine a point at which some huge expenditure of dollars would allow us to extend a patient's life, but we cannot afford to pay that money. Where and how we draw that line is fruitful area for discussion -- that the line exists somewhere seems pretty self-evident to me.

Or is anyone here actually taking the position that, as a society, we should never limit the dollars spent on any patient, under any circumstances?

I don't take that position. But the line ought to allow for spending for babies with defects that can be corrected by expensive surgeries- even very expensive surgeries. Where do you think the line should be?

[gamerunknown]

Originally Posted by Saint Cad

The reality is that medical costs need to be lowered in this county.

Republicans would despise a state actor in an economic decision.

Originally Posted by Terr

Social Security

Also with significantly lower administrative costs.. The total budget for the IRS in 2012 was 13.3bn. If we use 2010 data for GDP and percent of GDP expenditure on healthcare costs, then extrapolate 15% administrative fees and about half of the expenditure on healthcare being through private insurance, we get a figure of over 160bn being spent on administrative fees in the US. The article points out marginal utility of administrative expenses for increased expenditure on healthcare, which is a roundabout way of restating the reasonable opinion that private insurance for the already healthy does not warrant the current fees.

Originally Posted by adaher

ANd you all know I hate single payer, so if it keeps us from that, I'm all for it.

Why do you hate single payer? Healthcare fees are expected to rise in Europe to 14% of GDP by 2030, which is under the current rate paid in the US today.

Originally Posted by Bricker

Or is anyone here actually taking the position that, as a society, we should never limit the dollars spent on any patient, under any circumstances?

Isn't the Catholic position that a sin of omission is as grave as a committed sin? Thus removing a feeding tube is as dire as starving the person? There have been some fairly tortured theological screeds along the principle of the double effect too.

In this case, arguing for reasonable limits is precisely the act of omission which would lead to the death of an infant, by failing to provide the infant with adequate care. We're all coopted into the death panel, it's just Republicans want to limit the number of actors in it to the controllers of capital. See, wealth tracks merit, so if someone has a congenital condition without the means to pay for it, that's their own damn fault: the free market and mother nature working in harmony to purify humanity. Abortion is a different issue though, interference with the economic decisions of the foetus. Any amount of time or effort is warranted on behalf of the taxpayer in order to prevent a woman from ending the life of her genetically inferior burden in order to prevent a far more protracted, painful death and increased costs further on. Hardheaded sentimentality from the Gospel of Malthus.

[lance strongarm]

Originally Posted by gamerunknown

Why do you hate single payer? Healthcare fees are expected to rise in Europe to 14% of GDP by 2030, which is under the current rate paid in the US today.

I wonder if he wants to abolish Medicare too.

[Bricker]

Originally Posted by iiandyiiii

I don't take that position. But the line ought to allow for spending for babies with defects that can be corrected by expensive surgeries- even very expensive surgeries. Where do you think the line should be?

Unfortunately, I can't even agree with your second sentence. A million dollar surgery? Maybe. A five million dollar surgery? Ten? I can't sign on to the proposition that we must save a baby if we can, no matter what the cost. Because resources are not unlimited.

So you, rightly, ask me, "OK, where should the line be?"

I don't know. I don't even know how I'd begin to calculate that, especially knowing that I was potentially putting someone on the wrong side of that line with my decision.

But my wimping out doesn't change the math.

[WillFarnaby]

Originally Posted by lance strongarm

I trust that this was parody.

Fittingly, your trust is misplaced.

Society should only step in if the family is in financial need. With the ACA society steps in even if the family is well off and can afford the care. Fellow policy holders are shouldering the burden for everyone who requires expensive care, not just the needy.

The ACA should be repealed. Medicare should be repealed and poor old folks should be rolled over into Medicaid. Medicaid should be reformed and expanded to cover any expenses of poor people who cannot afford care. All insurance mandates should be repealed, allowing individuals to choose a plan best for their situation. Also, the deduction for medical premiums should be ended and taxes lowered accordingly to make up for the increase. This would sever personal medical plans from the employer and folks could use the money to purchase insurance from whomever they wish or just save money in case shit happens.

If these changes are made, medical care costs would fall tremendously and everyone who still couldn't afford care would be taken care of by society.

[Bricker]

Originally Posted by gamerunknown

Isn't the Catholic position that a sin of omission is as grave as a committed sin? Thus removing a feeding tube is as dire as starving the person? There have been some fairly tortured theological screeds along the principle of the double effect too.

In this case, arguing for reasonable limits is precisely the act of omission which would lead to the death of an infant, by failing to provide the infant with adequate care.

Not exactly. In fact, it's the principle of double effect which saves us: we are not refusing to care for the infant -- we are, instead, caring for other infants in a situation where we don't have the resources to care for all.

But I certainly don't think Catholic postulates should form the basis of secular policy -- do you?

[iiandyiiii]

Originally Posted by Bricker

Unfortunately, I can't even agree with your second sentence. A million dollar surgery? Maybe. A five million dollar surgery? Ten? I can't sign on to the proposition that we must save a baby if we can, no matter what the cost. Because resources are not unlimited.

So you, rightly, ask me, "OK, where should the line be?"

I don't know. I don't even know how I'd begin to calculate that, especially knowing that I was potentially putting someone on the wrong side of that line with my decision.

But my wimping out doesn't change the math.

Ok. But in the real world, do 5 and 10 million dollar surgeries exist (maybe they do- I'm really just asking)? How common are they? There probably should be a line. But (without doing the math) I think for non-elderly people (and especially children) the line ought to include pretty much every life-saving treatment. That doesn't include every medical situation (for example- what kind of prosthesis does an amputee get- the $10K version or the million dollar version? Probably "good" rather than "the very best" is good enough.). But I'm asking about the life-and-death ones. Like a patient with a chronic illness (perhaps HIV) that requires thousands of dollars of medication per month, with a long life expectancy as long as they stay on this expensive medication- if they're not rich, then either they need cap-free insurance (or the equivalent) or they're dead.

It seems to me that the Republican party position (from what I can tell- I don't think they've been asked this specifically) is that patients and families in situations like these must hope for charity or die. What's your position?

[DoctorJ]

Originally Posted by Bricker

Unfortunately, I can't even agree with your second sentence. A million dollar surgery? Maybe. A five million dollar surgery? Ten? I can't sign on to the proposition that we must save a baby if we can, no matter what the cost. Because resources are not unlimited.

So you, rightly, ask me, "OK, where should the line be?"

I don't know. I don't even know how I'd begin to calculate that, especially knowing that I was potentially putting someone on the wrong side of that line with my decision.

But my wimping out doesn't change the math.

It's not like this question has never been considered. The cost of lifesaving treatments is measured in cost per Quality Adjusted Life Year (QALY) gained. A year in perfect health is one QALY, and various conditions and ailments reduce that number; in theory, a year spent in what would be considered 50% of perfect health would be 0.5 QALYs. Coming up with that multiplier is extremely complicated, but there is a body of literature behind it.

So a treatment that costs $10,000 that gains someone ten years of perfect health costs $1,000 per QALY gained.

The cutoff for considering a treatment "cost-effective" is usually given as $50K per QALY gained. This is the result of some economics work in the 1980s, and that figure hasn't been adjusted for inflation--it is still the figure most people cite. So when we're talking about a baby that we're taking from certain death to a normal life, we can ballpark it at 60 QALYs gained, and it would be worth about $3 million.

This is not to say that we don't treat anything that costs more than $50K/QALY; in fact we do it all the time. Dialysis almost certainly costs more than that. Mammograms do if you do them every year. It's really the level at which we start to wonder if a certain treatment is worth the cost; below that we generally don't.

If nothing else, it's a very valid place to start the discussion.

[ElvisL1ves]

Fascinating, DoctorJ, thanks. Who is the existing "death panel" who performs the $/QALY calculation, btw? The hospital administration? And is the existence of insurance a consideration?

The political problem, of course, is that we already have rationing of health care under the current system, so decrying it in ACA is ignorant/hypocritical/all that.

[Voyager]

Originally Posted by Bricker

Not exactly. In fact, it's the principle of double effect which saves us: we are not refusing to care for the infant -- we are, instead, caring for other infants in a situation where we don't have the resources to care for all.

But I certainly don't think Catholic postulates should form the basis of secular policy -- do you?

Except for abortion policy, you mean.

Seriously, though, this is a discussion worth having. However your VP candidate 4 years ago pretty much shut it down with her "death panel" smear, which of course was just about paying for end of life counseling from doctors, and not about end of life decisions. We ration health care now, of course, but in an irrational way.

Part of ACA, I believe, is an attempt to start on evidence based medicine, that is paying for treatments that have been demonstrated to be effective. That should save money, while reducing waste.
The Medicare cuts that Ryan goes on about are not to patients, but for rates. Unless you micromanage healthcare, something that I don't want to see, this is a good way of reducing costs. After all, it is exactly what WalMart does using its market power with its suppliers. Anyone who has been to a range of doctors can see that some are far more efficient than others. Why not drive efficiency?

The free market has failed miserably in driving efficiency, which is not surprising since there is a good excuse for inefficiency and because there was incentive for inefficiency.

We've seen some consolidation as larger companies buy up capacity to prepare for a flood of new patients. They seem to be thinking they will profit under the new system. I'd be very happy if there is a reduction of healthcare costs and an increase in profits through the benefits of scale. Win-win.

[DoctorJ]

Originally Posted by ElvisL1ves

Fascinating, DoctorJ, thanks. Who is the existing "death panel" who performs the $/QALY calculation, btw? The hospital administration? And is the existence of insurance a consideration?

It depends on who and what you're talking about. When it comes to screening tests this all gets taken into account by the boards who make screening recommendations, like the US Preventive Services Task Force or the various medical specialty groups, and payers base what they'll pay for on those recommendations.

As to particular treatments, insurance companies definitely make calculations like this every day, as do Medicare/Medicaid regulators.